摘要
目的探讨5种止血手术治疗难治性产后m血的疗效及止血失败的原因。方法选择2007年1月至2011年7月四川大学华西第二医院收治的难治性产后出血产妇96例，采取的止血方法及例数：宫腔填塞纱条或球囊（填塞组）35例，盆腔血管结扎（结扎组）12例，盆腔动脉栓塞（介入组）9例，子宫压迫缝合（缝合组）26例及子宫压迫缝合＋宫腔填塞（缝合＋填塞组）14例。对各组产妇的止血手术中、术后情况及治疗结果进行分析，并对止血失败的原因行多因素分析。结果（1）96例产妇产后出血量1200～9100ml。实施以上止血手术后71例产妇止血成功，25例止血失败。（2）术前出血量介入组和填塞组明显多于缝合组，分别比较，差异均有统计学意义（P〈0．05）；术中出血量介入组和缝合组少于结扎组，分别比较，差异均有统计学意义（P〈0．05）；手术时间介入组明显短于结扎组、缝合组和缝合＋填塞组，分别比较，差异均有统计学意义（P〈0．05）。（3）96例产妇中，m血原因为宫缩乏力者55例，止血成功43例，止血成功率为78％；出血原因为前置胎盘者46例，止血成功39例，止血成功率为85％；出血原因为胎盘植入者33例，止血成功13例，止血成功率为39％。出血原因为官缩乏力及前置胎盘产妇的止血成功率在各组间比较，差异均无统计学意义（P〉0．05）；胎盘植入产妇的止血成功率在介入组中明显高于其他各组，差异均有统计学意义（P〈0．01）。（4）对25例止血失败产妇的原因进行多因素分析，结果显示，瘢痕子宫、胎盘植入、术前或术中存在凝血功能障碍是难治性产后出血止血失败的危险因素，OR值分别为2．9（95％CI为1．1～7．6）、17．9（95％CI为5．6～56．3）、16．2（95％CI为3．2—83．5）。介入治疗对止血成功具有一定的保护作用（OR=0．9，95％CI为0．8～0．9）。结论（1）5种止血手术对于难治性产后出血均有良好的止血效果，但盆腔动脉栓塞介入治疗具有手术时间短、术中卅血少的优势，尤其在有胎盘植入的情况下，介入治疗的止血成功率更高；（2）瘢痕子宫、胎盘植入及凝血功能障碍是止血失败的危险因素，对于有以上危险因素的难治性产后出血产妇应根据具体情况选择合适的止血方式。
Objective To study the different clinical effects of using 5 kinds of hemostatic surgeries to manage the intractable postpartum hemorrhage and analyse the risk factors of failed hemostasis. Methods From Jan. 2007 to Jul. 2011,96 patients with intractable postpartum hemorrhage were studied retrospectively and grouped by the first step surgical treatment. The hemostatic surgeries included uterine tamponade （tamponade group ）, pelvic blood vessels ligation （ligation group ）, pelvical arterial embolization （embolization group）, uterine compression sutures （sutures group） and uterine compression sutures combining tamponade （combined group）. The intraoperative and postoperation datum were compared among groups, so dose the treatment outcomes. Muhivariate analysis were used for failed hemostasis. Resolts （ 1 ） The blood loss of 96 patients ranged from 1200 to 9100 ml, and 71 patients had a succeed hemoatasis after employing these surgeries and 25 failed. （2） The blood loss before hemostasis surgeries in tamponade group and embolization group was statistically greater than in sutures group （ P 〈 O. 05 ）. Blood loss during the hemostasis surgeries in ligation group was statistically greater than in embolization and sutures groups （ P 〈 0. 05 ）. The operating time of embolization group was statistically shorter than ligation group, sutures group and the combined group （ P 〈 0. 05 ）. （ 3 ） Fine of 96 patients had uterine atony and 43 had a successful hemostasis with the success rate about 78%. Forty-six had placenta previa and 39 success with success rate 85%. Thirty-three had placenta accrete and 13 of which succeed in hemostasis with success rate about 39%. In patients with uterine atony and placenta previa, the difference of hemostasis rate in groups had no statistically significant （ P 〉 O. 05 ）. In patients with placenta accrete, the hemostasis rate in embolization group was higher than in others groups （P 〈 O. 01 ）. （4）The multivariate analysis found that scar uterus, placenta accrete and coagulation defects were the risk factors of failed hemotasis. The OR value respectively was 2.9 （95%CI：1, 1 -7.6）, 17.9（95%CI：5,6-56.3） and 16.2（95%CI：3.2-83.5）. Embolization had some extent of protective effection （ OR = 0. 9,95% CI： 0. 8 - 0. 9 ）. Conclusions （ 1 ） Five kinds of hemostatic surgeries were all effective. Though the success rate among groups did show statistical difference, pelvical arterial embolization has the comparative advantage of shorter operating time, less operating blood loss and higher success rate in placenta accrete. （2） Since scar uterus, placenta accrete and coagulation defects were the risk factors of failed hemostasis, sufficient preparation should be made for patients with these risk factors and the hemostatic surgeries should be choosed individually.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第9期641-645,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
产后出血
气囊阻塞
结扎术
栓塞
治疗性
治疗失败
Postpartum hemorrhage
Balloon occlusion
Ligation
Embolization, therapeutic
Treatment failure
作者简介
通信作者：刘兴会，Email：xinghuiliu@163．com
